Provider Demographics
NPI: | 1972801207 |
---|---|
Name: | NEUROPSYCHOLOGY & COMPLEMENTARY MEDICINE INC |
Entity Type: | Organization |
Organization Name: | NEUROPSYCHOLOGY & COMPLEMENTARY MEDICINE INC |
Other - Org Name: | NEUROPSYCHOLOGY AND COMPLEMENTARY MEDICINE OF FREDERICKSBURG |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CATHERINE |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | WARD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PSYD |
Authorized Official - Phone: | 540-999-6221 |
Mailing Address - Street 1: | PO BOX 845 |
Mailing Address - Street 2: | |
Mailing Address - City: | FREDERICKSBURG |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22404-0845 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 540-999-6221 |
Mailing Address - Fax: | 866-481-8299 |
Practice Address - Street 1: | 3504 PLANK RD |
Practice Address - Street 2: | SUITE 302 |
Practice Address - City: | FREDERICKSBURG |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22407-6896 |
Practice Address - Country: | US |
Practice Address - Phone: | 540-999-6221 |
Practice Address - Fax: | 866-481-8299 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-03-10 |
Last Update Date: | 2011-10-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
No | 103TE1100X | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports | Group - Multi-Specialty |
No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Multi-Specialty |
No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health | Group - Multi-Specialty |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
No | 171100000X | Other Service Providers | Acupuncturist | Group - Multi-Specialty | |
No | 174H00000X | Other Service Providers | Health Educator | Group - Multi-Specialty | |
No | 175F00000X | Other Service Providers | Naturopath | Group - Multi-Specialty | |
No | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | Group - Multi-Specialty |
No | 221700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Art Therapist | Group - Multi-Specialty | |
No | 225400000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | Group - Multi-Specialty | |
No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 1972801207 | Medicaid |